On This Day … 21 January

People (Births)

Wolfgang Kohler

Wolfgang Köhler (21 January 1887 to 11 June 1967) was a German psychologist and phenomenologist who, like Max Wertheimer and Kurt Koffka, contributed to the creation of Gestalt psychology.

During the Nazi regime in Germany, he protested against the dismissal of Jewish professors from universities, as well as the requirement that professors give a Nazi salute at the beginning of their classes. In 1935 he left the country for the United States, where Swarthmore College in Pennsylvania offered him a professorship. He taught with its faculty for 20 years, and did continuing research. A Review of General Psychology survey, published in 2002, ranked Köhler as the 50th most cited psychologist of the 20th century.

Joseph Nicolosi

Joseph Nicolosi (24 January 1947 to 08 March 2017) was an American clinical psychologist who advocated and practised “reparative therapy”, a form of the pseudoscientific treatment of conversion therapy that he claimed could help people overcome or mitigate their homosexual desires and replace them with heterosexual ones. Nicolosi was a founder and president of the National Association for Research and Therapy of Homosexuality (NARTH). Medical institutions warn that conversion therapy is ineffective and may be harmful, and that there is no evidence that sexual orientation can be changed by such treatments.

Nicolosi described his ideas in Reparative Therapy of Male Homosexuality: A New Clinical Approach (1991) and three other books. Nicolosi proposed that homosexuality is often the product of a condition he described as gender-identity deficit caused by an alienation from, and perceived rejection by, formative individuals of the subject’s gender which interrupts normal masculine or feminine identification process. He also held that adaptation to gender trauma during formative years could alienate a child from their “fundamental nature.” His goal was to restore “that which functions in accordance with its biological design.”

What is Improving Access to Psychological Therapies?

Introduction

Improving Access to Psychological Therapies (IAPT) is a National Health Service (England) initiative to provide more psychotherapy to the general population.

It was developed and introduced by the Labour Party as a result of economic evaluations by Professor Lord Richard Layard, based on new therapy guidelines from the National Institute for Health and Care Excellence as promoted by clinical psychologist David M. Clark.

Brief History

Richard Layard, a labour economist at the London School of Economics, had become influential in New Labour party politics and was appointed to the House of Lords in 2000. He had a particular interest in the happiness of populations and mental health; his father, John Layard, was an anthropologist who had survived suicidal depression and retrained as a Jungian psychologist after undergoing psychoanalysis by Carl Jung. In 2003 Richard Layard met the clinical psychologist David M. Clark, a leading figure in Cognitive Behavioural Therapy who was running the Centre for Anxiety Disorders and Trauma (with Anke Ehlers and Paul Salkovskis) at the Institute of Psychiatry and Maudsley Hospital. Clark professed to high rates of improvement from CBT but low availability of the therapy despite NICE guidelines now recommending it for several mental disorders.

Layard, with Clark’s help, set about campaigning for a new national service for NICE-recommended treatments, particularly CBT. One key argument was that it would be cost-effective and indeed eventually pay for itself by increasing productivity and reducing state benefits such as Disability Living Allowance and Incapacity Benefit (which had seen rising claims since their introduction by John Major’s Conservative Party in 1992 and 1995 respectively). The plan was accepted in principle by the newly re-elected Labour government in 2005 and gradually put into practice directed by Clark. Layard names several others as having helped gain the initial political traction for the initiative – MP Ed Miliband, psychiatrist Louis Appleby (then National Director for Mental Health), David Halpern (psychologist), psychiatrist David Nutt, MP Alan Milburn (married to a psychiatrist) and eventually the Prime Minister Gordon Brown.

In 2006 the Mental Health Policy Group at the LSE published ‘The Depression Report’, commonly referred to as the Layard Report, advocating for the expansion of psychotherapy on the NHS. This facilitated the development of IAPT initiatives, including two demonstration sites (pilot studies) and then training schemes for new types of psychological practitioner. The programme was officially announced in 2007 on World Mental Health Day. Some mental health professionals cast doubt on the claims early on. In the official publication of the British Psychological Society in 2009, experienced clinical psychologists John Marzillier and Professor John Hall strongly criticised IAPT’s promoters for glossing over both the data gaps acknowledged in the NICE reports and the complexity of the multiple issues typically affecting people with mental health problems and their ability to sustain employment; they were met with much agreement as well as angry criticism. One researcher cited the UK initiative as the most impressive plan to disseminate stepped-care cognitive behaviour therapy. But the plan appears not to have worked, Davis (2020) in the Journal of Evidence Based Mental Health, noted that 73% of IAPT clients receive low intensity therapy first (guided self help, computer assisted CBT or group psychoeducation) but only 4 % are transferred to high intensity therapy and the first transition appointment is the least well attended.

Aims

The aim of the project is to increase the provision of evidence-based treatments for common mental health conditions such as anxiety and depression by primary care organisations. This includes workforce planning to adequately train the mental health professionals required. This would be based on a ‘stepped care’ or triage model where ‘low intensity’ interventions or self-help would be provided to most people in the first instance and ‘high intensity’ interventions for more serious or complex conditions. Outcomes would be assessed by standardised questionnaires, where sufficiently high initial scores (a ‘case’) and sufficiently low scores immediately after treatment (below ‘caseness’), would be classed as ‘moving to recovery’. The NICE (National Institute for Health and Clinical Excellence) therapy guidelines presume reliable diagnosis. IAPT therapists do not make formal diagnoses. This calls into question IAPT’s claimed fidelity to the NICE guidelines, particularly as it does not monitor therapists treatment adherence.

Evaluation

Initial demonstration sites reported outcomes in line with predictions in terms of the number of people treated (especially with ‘low intensity’ interventions such as ‘guided self-help’) and the percentages classified as recovered and as in more employment (a small minority) to ten months later. It was noted that the literature indicates a substantial proportion of patients would recover anyway with the passage of time or with a placebo – in fact the majority of those whose condition had lasted for less than six months, but only a small minority of those whose condition had been longer-lasting.

There has been some debate over whether IAPT’s roll-out may result initially in low quality therapy being offered by poorly trained practitioners.

Beacon UK benchmarked IAPT performance across England for 2011-2012 and reported that 533,550 people accessed (were referred to) IAPT services – 8.7% of people suffering from anxiety and depression disorders – with around 60% entering treatment sessions. Most local IAPT services did not reach the target of a 50% ‘recovery’ rate.

In 2012-2013, 761,848 people were referred to IAPT services. 49% went into treatment (the rest either assessed as unsuitable for IAPT or declined), although around half of those dropped out before completing at least two sessions. Of the remainder, 127,060 people had pre-treatment and post-treatment mental health questionnaires submitted indicating ‘recovery’ – a headline rate of 43%. A report by the University of Chester indicated that sessions were costing three times more to fund than the original Department of Health estimates.

For 2014-2015 there were nearly 1.3 million referrals to IAPT, of which 815,665 entered treatment. Of those, 37% completed sufficient sessions, with 180,300 showing a ‘reliable recovery’ (on anxiety and depression questionnaires completed before and immediately after treatment) – which was just over one in five of those who entered treatment, just under half of those who completed enough sessions. Opinion on IAPT remained divided. The number of trained IAPT therapists did not appear to have met the government’s target of 6000, resulting in high caseloads. Some complained of seeing more ‘revolving door’ patients and excess complexity of cases, while the NHS has acknowledged problems with waiting times and recovery rates. However Norman Lamb, who championed IAPT within the coalition government 2010-2015, disagreed with picking faults with such an extensive and world-leading advance in evidence-based treatment. Others lauded the success in rising numbers of referrals, but warned of the failure to improve recovery rates. It was noted that both antidepressant prescribing and psychiatric disability claims have continued to rise.

In 2017 fewer than half of the Clinical Commissioning Groups met the target (15.8%) for the number of people who should be accessing talking therapies. There has been no publicly funded independent audit of IAPT . A study of 90 IAPT cases assessed with a ‘gold standard’ diagnostic interview revealed that only the tip of the iceberg recovered, in the sense of losing their diagnostic status. The results were identical whether or not the person was treated before or after personal injury litigation.

In July 2021 55,703 appointments out of the total 434,000 which went ahead involved one or more practitioners who did not have an accredited IAPT qualification. There are about 2000 psychological wellbeing practitioners in the service, with another 1,200 trainees. They are supported by high intensity therapists and counsellors of which there are about 4,000 with 700 trainees.

Updates

In December 2010, Paul Burstow, Minister for Care Services, announced an extension to the IAPT project to include Children and Young Peoples services. The government pledged £118m annually from 2015 to 2019 to increase access to psychological therapies services to children and young people.

When the programme officially started in 2008 it was only for working age adults, but in 2010 it was opened to all ages.

In 2015 Clark and fellow clinical psychologist Peter Fonagy, writing in response to wide-ranging criticism from child and adolescent psychiatrist Sami Timimi, stated that IAPT now has increasing support for the non-CBT modalities recommended by NICE for depression: counselling, couples therapy, interpersonal psychotherapy and brief psychodynamic therapy; and for Children and Young People (CYP-IAPT) more systemic family therapy, interpersonal therapy and parenting therapy is on the way. Timimi described the changes as still “light” on relational/collaborative therapy compared to the ‘technical model’ derived from ’eminence-based’ NICE guidelines via inadequate diagnostic categories.

A Payment by Results system is being developed for IAPT, whereby each local Clinical Commissioning Group can reward each local provider according to various targets met for the service and for each client – particularly for how much change in scores on the self-report questionnaires. The March 2021 issue of the British Journal of Clinical Psychology has highlighted the considerable controversy over IAPT’s claims of success, Scott( 2021) and Kellett et al., (2021) have responded with their own commentary ‘The costs and benefits of practice-based evidence: Correcting some misunderstandings about the 10-year meta-analysis of IAPT studies’.

On This Day … 15 August

People (Births)

  • 1933 – Stanley Milgram, American social psychologist (d. 1984).
  • 1958 – Simon Baron-Cohen, English-Canadian psychiatrist and author.

Stanley Milgram

Stanley Milgram (15 August 1933 20 December 1984) was an American social psychologist, best known for his controversial experiments on obedience conducted in the 1960s during his professorship at Yale.

Milgram was influenced by the events of the Holocaust, especially the trial of Adolf Eichmann, in developing the experiment. After earning a PhD in social psychology from Harvard University, he taught at Yale, Harvard, and then for most of his career as a professor at the City University of New York Graduate Centre, until his death in 1984.

His small-world experiment, while at Harvard, led researchers to analyse the degree of connectedness, including the six degrees of separation concept. Later in his career, Milgram developed a technique for creating interactive hybrid social agents (called cyranoids), which has since been used to explore aspects of social- and self-perception.

He is widely regarded as one of the most important figures in the history of social psychology. A Review of General Psychology survey, published in 2002, ranked Milgram as the 46th-most-cited psychologist of the 20th century.

Simon Baron-Cohen

Sir Simon Philip Baron-Cohen FBA FBPsS FMedSci (born 15 August 1958) is a British clinical psychologist and professor of developmental psychopathology at the University of Cambridge. He is the director of the university’s Autism Research Centre and a Fellow of Trinity College. In 1985, Baron-Cohen formulated the mind-blindness theory of autism, the evidence for which he collated and published in 1995. In 1997, he formulated the foetal sex steroid theory of autism, the key test of which was published in 2015.

He has also made major contributions to the fields of typical cognitive sex differences, autism prevalence and screening, autism genetics, autism neuroimaging, autism and technical ability, and synaesthesia. Baron-Cohen was knighted in the 2021 New Year Honours for services to autistic people.

Book: Clinical Psychology: An Introduction

Book Title:

Clinical Psychology: An Introduction.

Author(s): Alan Carr.

Year: 2012.

Edition: First (1st).

Publisher: Routledge.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Clinical Psychology is for students studying clinical psychology as part of an undergraduate programme in psychology, nursing, sociology or social and behavioural sciences. Undergraduate students who wish to know if postgraduate study in clinical psychology would be of interest to them will find this book particularly useful.

The book will inform students about:

  • The profession of clinical psychology.
  • How to get onto a clinical psychology postgraduate training programme.
  • The way clinical psychologists work with children, adolescents and adults with common psychological problems.
  • The main models of practice used by clinical psychologists, and.
  • The scientific evidence for the effectiveness of psychological interventions.

There is a focus on both clinical case studies and relevant research, and the book includes summaries, revision questions, advice on further reading and a glossary of key terms, all of which make it an excellent student-friendly introduction to an exceptionally interesting subject.

Book: Clinical Psychology

Book Title:

Clinical Psychology (Topics in Applied Psychology).

Author(s): Graham Davey, Nick Lake, and Adrian Whittington (Editors).

Year: 2015.

Edition: Second (2nd).

Publisher: Routledge.

Type(s): Hardcover, Paperback and Kindle.

Synopsis:

Clinical Psychology, Second Edition offers a comprehensive and an up-to-date introduction to the field. Written by clinical practitioners and researchers, as well as service users who add their personal stories, the book provides a broad and balanced view of contemporary clinical psychology.

This new edition has been extensively revised throughout and includes a new section on working with people with disabilities and physical health problems. It also includes a new chapter on career choices, and help and advice on how to move forward into clinical psychology training.

The book starts by explaining the core elements of what a clinical psychologist does and the principles of clinical practice, as well as outlining the role of the clinical psychologist within a healthcare team. It goes on to cover issues involved with working with children and families, adult mental health problems, working with people with disabilities and physical health problems, and the use of neuropsychology. The final part of the book explores current professional issues in clinical psychology, the history and future of clinical psychology, and career options.

The integrated and interactive approach, combined with the comprehensive coverage, make this book the ideal companion for undergraduate courses in clinical psychology, and anyone interested in a career in this field. It will also be of interest to anyone who wants to learn more about the work of a clinical psychologist, including other healthcare professionals.

Book: Clinical Psychology for Trainees: Foundations of Science-Informed Practice

Book Title:

Clinical Psychology for Trainees: Foundations of Science-Informed Practice.

Author(s): Andrew C. Page and Werner G.K. Stritzke.

Year: 2014.

Edition: Second (2nd).

Publisher: Cambridge University Press.

Type(s): Paperback and Kindle.

Synopsis:

Thoroughly revised, and fully updated for DSM-5, the new edition of this practice-focused book guides clinical psychology trainees through a field which is rapidly evolving. Through real-world exploration of the scientist-practitioner model, the book helps readers to develop the core competencies required in an increasingly interdisciplinary healthcare environment. New chapters cover brief interventions, routine monitoring of treatment progress, and managing alliance ruptures. Practical skills such as interviewing, diagnosis, assessment, treatment and case management are discussed with emphasis on the question ‘how would a scientist-practitioner think and act?’ By demonstrating how an evidence-base can influence every decision that a clinical psychologist makes, the book equips trainees to deliver the accountable, efficient, effective client-centred service which is demanded of professionals in the modern integrated care setting. Essential reading for all those enrolled in, or contemplating, postgraduate studies in clinical psychology.

Book: Clinical Psychology in Practice

Book Title:

Clinical Psychology in Practice.

Author(s): Helen Beinart, Paul Kennedy, and Susan Llewelyn (Editors).

Year: 2009.

Edition: First (1st).

Publisher: WB.

Type(s): Paperback and eBook.

Synopsis:

Academic, clinical and research aspects are offered in collaboration with clinical practitioners, who provide the clinical experience to foster the development of competencies in Health and Social Care.

  • Provides a clear, authoritative and lively introduction to the practice of clinical psychology.
  • Explains succinctly the range of competencies which a psychologist is expected to possess, and how these can be applied in a variety of contexts.
  • Key issues covered include awareness of the social context, the need for responsive and flexible practice, and respect for diversity.
  • Examples and principles are provided which demonstrate the clinical psychologist in action, and explain why and how they work as they do.

Book: Clinical Psychology, Research and Practice

Book Title:

Clinical Psychology, Research and Practice: An Introductory Text.

Author(s): Paul Bennett.

Year: 2021.

Edition: Fourth (4th).

Publisher: Open University Press.

Type(s): Paperback and Kindle.

Synopsis:

Extensively updated, this popular and accessibly written textbook outlines the latest research and therapeutic approaches within clinical psychology, alongside important developments in clinical practice. The book introduces and evaluates the conceptual models of mental health problems and their treatment, including second and third wave therapies.

Each disorder is considered from a psychological, social and biological perspective and different intervention types are thoroughly investigated.

Key updates to this edition include:

  • The development of case formulations for conditions within each chapter.
  • An articulation and use of modern theories of psychopathology, including sections on the transdiagnostic approach, meta-cognitive therapy, and acceptance and commitment therapy.
  • An introduction to emerging mental health issues, such as internet gaming disorder.
  • Challenging ‘stop and think’ boxes that encourage readers to address topical issues raised in each chapter, such as societal responses to topics as varied as psychopathy, paedophilia and the Black Lives Matter movement.
  • New vocabulary collated into key terms boxes for easy reference.

Book: Becoming a Clinical Psychologist: Everything You Need to Know

Book Title:

Becoming a Clinical Psychologist: Everything You Need to Know.

Author(s): Steven Mayers and Amanda Mwale.

Year: 2018.

Edition: First (1st).

Publisher: Routledge.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Becoming a Clinical Psychologist: Everything You Need to Know brings together all the information you need to pursue a career in this competitive field.

This essential guide includes up-to-date information and guidance about a career in clinical psychology and gaining a place on clinical psychology training in the UK. It answers the questions all aspiring psychologists need to know, such as:

  • What is clinical psychology?
  • What is it like to train and work as a clinical psychologist?
  • How to make the most of your work and research experience.
  • How to prepare for clinical psychology applications and interviews.
  • Is clinical psychology the right career for me?

By cutting through all the jargon, and providing detailed interviews with trained and trainee clinical psychologists, Becoming a Clinical Psychologist will provide psychology graduates or undergrads considering a career in this area with all the tools they need.

Book: Borderline Personality Disorder For Dummies

Book Title:

Borderline Personality Disorder For Dummies, 2nd Edition.

Author(s): Charles H. Elliott and Laura L. Smith.

Year: 2020.

Edition: Second (2nd).

Publisher: For Dummies..

Type(s): Paperback and Kindle.

Synopsis:

Borderline personality disorder (BPD) is an extremely serious – and often seriously neglected – condition. Despite around 4 million diagnoses in the US, BPD has attracted lower funding and levels of clinical concern than more “popular” conditions such as bipolar disorder. But there’s no need to lose hope! Borderline Personality Disorder For Dummies, 2nd Edition was written to bridge this gap and help sufferers learn how to break the cycle to lead a full and happy life.

BPD impacts the way you think and feel about yourself and others and can cause long-term patterns of disruptive relationships and difficulties with self-control. It often results from childhood abuse or neglect, as well as from genetic or brain abnormalities – particularly in areas of the brain that regulate emotion, impulsivity, and aggression. Knowing how it works means we know how to manage it, and Borderline Personality Disorder For Dummies – written in a friendly, easy-to-follow style by two leading clinical psychologists – is packed with useful techniques to do just that: from identifying triggers to finding the right care provider.

  • Get a compassionate, actionable understanding of the symptoms and history of BPD.
  • Acquire techniques to identify and halt damaging behaviours.
  • Evaluate providers and the latest therapies and treatments.
  • Set goals and habits to overcome problems step-by-step.

BPD should never be allowed to dictate anyone’s existence. This reference gives you the tools to take your life back and is a must-have for sufferers and their loved ones alike.